Healthy men who drink moderately have reduced risk of heart attack

For men with healthy lifestyle habits, drinking moderate amounts of alcohol may be associated with a lower risk of heart attack than drinking heavily or not drinking at all, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Previous studies have found that adults who drink moderate amounts of alcohol have a lower risk of myocardial infarction (heart attack) than those who do not drink at all, according to background information in the article. Researchers suspect this is due to increased levels of HDL or "good" cholesterol in the blood. Because there are many risks associated with heavy drinking, physicians do not typically recommend that patients begin drinking alcohol to reduce their heart disease risk--instead, they focus on other proven lifestyle interventions, including diet and exercise. However, these habits are not mutually exclusive, the authors write. "For individuals who exercise, abstain from smoking, maintain optimal weight and adhere to an appropriate diet, there may be few other standard lifestyle interventions to lower risk," the authors write. "Whether alcohol intake is related to a lower risk for myocardial infarction in such individuals is unknown."

Kenneth J. Mukamal, M.D., M.P.H., M.A., Beth Israel Deaconess Medical Center, Boston, and colleagues assessed the connection between drinking alcohol and heart attack in 8,867 healthy men who were part of the Health Professionals Follow-up Study, which began in 1986 and included 51,529 dentists, pharmacists, veterinarians and other health care professionals age 40 to 75. At the beginning of the study and at regular intervals afterward, the participants filled out questionnaires about their diets and medical conditions, reported the frequency with which they consumed particular substances and specified the types of alcohol they drank. All of the men in the current study had healthy lifestyles, defined as not smoking, having a body mass index (BMI) of less than 25, getting at least 30 minutes of exercise per day and eating a healthy diet, including large amounts of fruits, vegetables, fish and polyunsaturated fats and low amounts of trans-fats and red meat.

Between 1986 and 2002, 106 men had heart attacks. This included eight of the 1,282 who drank 15 to 29.9 grams of alcohol per day (about two drinks), nine of the 714 who drank 30 grams or more per day, 34 of the 2,252 who drank .1 to 4.9 drinks per day and 28 of the 1,889 who did not drink at all. Those who drank 15 to 29 grams per day had the lowest risk for heart attack and those who did not drink at all had the highest. The researchers also performed an analyses comparing those who drank 5 grams per day or more and those who drank less than 5 grams a day. For the latter, "we estimate that 25 percent of the incidence cases of myocardial infarction in this population were attributable to consuming less than 5 grams per day," the authors write.

"There is a complicated mix of risks and benefits attributed to moderate drinking in observational studies, and the individual and societal complications of heavy drinking are well known," the authors conclude. "It is easy to understand why clinical guidelines encourage physicians and patients to concentrate on seemingly more innocuous interventions, despite the relative paucity of effective, straightforward and generalizable methods for encouraging regular physical activity, weight reduction and abstinence from smoking in clinical practice. Our results suggest that moderate drinking could be viewed as a complement, rather than an alternative, to these other lifestyle interventions, a viewpoint espoused by some authors."

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(Arch Intern Med. 2006;166:2145-2150. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by grants from the National Institutes of Health. Co-author Dr. Rimm has received honoraria for occasional speaking engagements at research conferences from industry-related organizations (Distilled Spirits Council and National Beer Wholesalers Association). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.